Exercise and antidepressants improve fibromyalgia.

Consider the differential diagnosis carefully. A person who meets the criteria for fibromyalgia may have yet another cause of chronic pain, such as rheumatoid arthritis, or may instead have a different treatable condition that mimics fibromyalgia. Drug-induced myopathy. Pain suggestive of fibromyalgia should prompt a review of the patient’s medicines. Drug-induced myopathy may occur in persons taking colchicine, statins, corticosteroids, or antimalarial drugs. Connective tissue, autoimmune, and rheumatologic disorders. Consider this group of disorders next. In 1 study, one fourth of persons referred to a rheumatology clinic with presumed fibromyalgia instead had a spondyloarthropathy. Dermatomyositis and polymyositis may present with muscle pain and tenderness but, unlike fibromyalgia, cause proximal muscle weakness. Systemic lupus erythematosus, rheumatoid arthritis, and polymyalgia rheumatica can also lead to widespread pain. Blood tests such as antinuclear antibody (ANA), C-reactive protein, or erythrocyte sedimentation rate (ESR) may prove helpful when a patient has a history of unexplained rashes, fever, weight loss, joint swelling, iritis, hepatitis, Corresponding author: Anna Quisel, MD, c/o Cheryl Mongillo, Department of Family and Community Medicine, Christiana Care Health Systems, 1401 Foulk Road, Wilmington, DE 19803. E-mail: [email protected]. Practice recommendations